9 CRR-NY 9720.2NY-CRR
9 CRR-NY 9720.2
9 CRR-NY 9720.2
9720.2 Right to a fair hearing.
(a) Applicants and participants shall be entitled to a fair hearing to have a contractor's determination after reconsideration reviewed on the following grounds:
(1) denial of benefits;
(2) failure to determine the applicant's eligibility or, if found eligible, failure to issue a card or authorize services within three days from the date the applicant met his/her registration fee, premium or deductible requirement;
(3) discontinuance or suspension of coverage, in whole or in part;
(4) computation of his/her cost-sharing responsibilities;
(5) any other grounds affecting the applicant or participant's coverage, including a determination of the receipt of medical assistance or equivalent or better public or private insurance benefits.
(b) Notwithstanding the above, participants have no right to a hearing when the contractor discontinues payment to a provider or the panel authorizes a mass change.
9 CRR-NY 9720.2
Current through September 15, 2021
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IMPORTANT NOTE REGARDING CONTENT CURRENCY: JULY 31, 2023, is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Admisnistrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of the NYS Rules.